Abstract WP174: Frequency, Predicators, and Outcomes of Pre-Intervention Thrombus Migration in Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion

• Published in: Stroke (1970) 2019-02, Vol.50 (Suppl_1)
• Main Authors: Lee, Kee Ook, Liebeskind, David, Jahan, Reza, Starkman, Sidney, Sharma, Latisha, Yoo, Bryan, Avelar, Johanna, Rao, Neal, Hinman, Jason, Duckwiler, Gary, Nour, May, Szeder, Viktor, Tateshima, Satoshi, Colby, Geoffrey, Hosseini, Mersedeh Bahr, Raychev, Radoslav, Kim, Doojin, Vespa, Paul M., Blanco, Manuel M. Buitrago, Saver, Jeffrey L.
• Format: Article
• Language: English
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.50.suppl_1.WP174

Abstract only Background: In patients presenting with acute ischemic stroke (AIS) due to large vessel occlusion (LVO), between initial CTA/MRA and catheter angiography performed for intervention, the occlusive thrombus may persist unchanged, fragment and migrate distally, or resolve completely, with or without bridging intravenous fibrinolytic treatment. The frequency, predictors, and outcomes of pre-intervention thrombus migration not been well delineated. Methods: We analyzed a prospectively maintained registry of AIS-LVO patients at an academic medical center over a 2.8 year period (Dec 2014-Oct 2017). Comparing occlusion sites on arrival CTA/MRA with immediately following interventional angiogram, patients were classified as having: 1) thrombus persistence (TP), 2) thrombus migration (TM), or 3) thrombus resolution (TR). Results: In the 220 patients, mean age was 70.7, 42.7% were female, NIHSS was 13.8, onset to first imaging was 156 minutes, and initial occlusion sites on MRA/CTA were: ICA-20.5%; MCA-67.3%; VA/BA-12.3%. Frequencies of thrombus evolution patterns were: TP-59.5%; TM-30.5%; TR-10.0%. On multivariate analysis, independent predictors of TM were: higher NIHSS (OR 1.06 per 1 pt), cardioembolic mechanism (OR 2.40), and longer time from last known well to first CTA/MRA imaging (OR 1.08 per 60 min). While rates of substantial reperfusion (TICI 2b-3) were similar (85.2% vs 83.7%), patients with TM rather than TP had lower rates of excellent reperfusion (TICI 2C-3), 24.1% vs 44.2%, p = 0.02. Symptomatic intracranial hemorrhage occurred more often in TM than TP, 17.9% vs 8.4%, p = 0.05. In multivariate analysis, TM was independently associated with reduced rates of good functional outcome (mRS 0-2), both at discharge (OR 0.41, 95% CI 0.19 to 0.90; p=0.03) and at 3 months (OR 0.43, 95% CI 0.19 to 0.94; p=0.03). Conclusions: Early TM between initial noninvasive imaging and interventional angiography occurs in nearly one-third of patients, is paradoxically associated with poorer outcomes, including more symptomatic hemorrhage and reduced final functional independence. Better understanding of dynamic clot changes early after arrival and their effects on outcome may aid further development of reperfusion therapeutics.